January 15, 2010

North Carolina Medicare Cuts to Skilled Nursing Facility Care

Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina

House Senate Latest Proposal

Proposal $ 679.9 million $ 415.4 million $ 444.0 million

Final Rule $ 341.0 million $ 341.0 million $ 341.0 million

Total $ 1.0 billion $ 756.4 million $ 785.0 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 1

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 1

House Senate Latest Proposal

Proposal $ 68.2 million $ 41.9 million $ 44.4 million

Final Rule $ 34.8 million $ 34.8 million $ 34.8 million

Total $ 103.0 million $ 76.7 million $ 79.2 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 2

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 2

House Senate Latest Proposal

Proposal $ 43.6 million $ 27.7 million $ 27.8 million

Final Rule $ 24.6 million $ 24.6 million $ 24.6 million

Total $ 68.2 million $ 52.4 million $ 52.4 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 3

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 3

House Senate Latest Proposal

Proposal $ 30.8 million $ 18.7 million $ 20.2 million

Final Rule $ 15.2 million $ 15.2 million $ 15.2 million

Total $ 46.0 million $ 33.9 million $ 35.4 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 4

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 4

House Senate Latest Proposal

Proposal $ 45.4 million $ 27.4 million $ 29.8 million

Final Rule $ 21.9 million $ 21.9 million $ 21.9 million

Total $ 67.3 million $ 49.3 million $ 51.7 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 5

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 5

House Senate Latest Proposal

Proposal $ 51.4 million $ 31.3 million $ 33.7 million

Final Rule $ 25.4 million $ 25.4 million $ 25.4 million

Total $ 76.8 million $ 56.7 million $ 59.1 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 6

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 6

House Senate Latest Proposal

Proposal $ 43.6 million $ 26.1 million $ 28.8 million

Final Rule $ 20.4 million $ 20.4 million $ 20.4 million

Total $ 64.0 million $ 46.5 million $ 49.3 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 7

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 7

House Senate Latest Proposal

Proposal $ 53.3 million $ 33.1 million $ 34.5 million

Final Rule $ 28.1 million $ 28.1 million $ 28.1 million

Total $ 81.5 million $ 61.3 million $ 62.6 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 8

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 8

House Senate Latest Proposal

Proposal $ 60.9 million $ 37.0 million $ 39.9 million

Final Rule $ 30.0 million $ 30.0 million $ 30.0 million

Total $ 90.9 million $ 67.1 million $ 69.9 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 9

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 9

House Senate Latest Proposal

Proposal $ 43.6 million $ 26.1 million $ 28.8 million

Final Rule $ 20.6 million $ 20.6 million $ 20.6 million

Total $ 64.2 million $ 46.7 million $ 49.4 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 10

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 10

House Senate Latest Proposal

Proposal $ 60.2 million $ 36.3 million $ 39.7 million

Final Rule $ 28.9 million $ 28.9 million $ 28.9 million

Total $ 89.1 million $ 65.2 million $ 68.6 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 11

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 11

House Senate Latest Proposal

Proposal $ 76.8 million $ 47.2 million $ 50.0 million

Final Rule $ 39.1 million $ 39.1 million $ 39.1 million

Total $ 115.9 million $ 86.3 million $ 89.1 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 12

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 12

House Senate Latest Proposal

Proposal $ 55.0 million $ 33.6 million $ 35.9 million

Final Rule $ 27.6 million $ 27.6 million $ 27.6 million

Total $ 82.5 million $ 61.1 million $ 63.5 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

North Carolina Congressional District 13

Medicare Cuts to Skilled Nursing Facility Care Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts North Carolina Congressional District 13

House Senate Latest Proposal

Proposal $ 47.0 million $ 29.0 million $ 30.5 million

Final Rule $ 24.3 million $ 24.3 million $ 24.3 million

Total $ 71.3 million $ 53.3 million $ 54.8 million

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.

January 15, 2010

United States Medicare Cuts to Skilled Nursing Facility Care

Medicare payments for skilled nursing facility services have been reduced on October 1, 2009. In addition, health care reform bills have been passed in both chambers of Congress that also include cuts for Medicare skilled nursing services. The cuts are listed below. Each impact listed is for a ten-year period from October 1, 2010 through September 30, 2019. Final Rule– The Centers for Medicare and Medicaid Services reduced payments for skilled nursing facility (“SNF”) services by 3.3% effective October 1, 2009 to apply a parity adjustment. The estimated impact of this rule on a national basis is a cut in payments of $12.0 billion. House of Representatives – H.R. 3962, Affordable Health Care for America Act– The House of Representatives passed H.R. 3962 on November 8, 2009. Under this bill, the 2.2% SNF market basket update, a cost of living adjustment, would be removed from January 1, 2010 through September 30, 2010. In addition, for each year, beginning in FY2011, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $23.9 billion. Senate – H.R. 3590, Patient Protection and Affordable Care Act– The Senate passed H.R. 3590 on December 24, 2009. Under this bill, for each year, beginning in FY2012, a productivity adjustment estimated at 1.4% of the SNF rate would be applied. The estimated impact of this bill on a national basis is a cut in payments of $14.6 billion. Latest Proposal– The latest proposal is a reduction of $15.6 billion on a national basis. The specifics of this proposal have not been disclosed at this time. The likely provisions include a productivity adjustment.

Medicare Cuts United States

House Senate Latest Proposal

Proposal $ 23.9 billion $ 14.6 billion $ 15.6 billion

Final Rule $ 12.0 billion $ 12.0 billion $ 12.0 billion

Total $ 35.9 billion $ 26.6 billion $ 27.6 billion

Sources of information used in calculations: CBO scores dated July 17, 2009, September 16, 2009, and October 29, 2009, Medicare patient days for fiscal year 2007. Copyright, American Health Care Association, 2010. Prepared by American Health Care Association, Research Department.